Yale University · 18 hours ago
Quality Improvement Analyst
United States
Full-time
Remote
Mid, Senior Level
$90K/yr - $166K/yr
5+ years expYale University is seeking a Quality Improvement Analyst to collaborate with operational leaders to ensure accurate claims processing and network compliance. The role involves promoting quality claims management by detecting improvement opportunities and implementing corrective actions.
AssociationBusiness DevelopmentEducationMedicalSocial Entrepreneurship
Responsibilities
Audit system configuration against provider contract requirements
Identify fee schedule, provider rate, and benefit setup discrepancies
Collaborate with IT and operations to resolve claims configuration gaps
Perform routine and complex audits of claim transactions processed within our Production a to validate results and communicate exceptions
Detailed review of internal and external reporting
Support quarterly claim audits and updates
Assess the impact of configuration changes by processing claim adjustments, manual claim entry, void-reissue of payment, etc
Support new claims adjudication by validating benefits and claims logic were loaded correctly
Develop and prepare reporting results of findings from process audits and testing
Assisting in identifying the root cause of errors inline to system configuration vs manual processing
Assist in drafting reimbursement policies
Support network assessment and gap identification
Help identify solutions for system issues impacting claim processing results
Provide audit feedback to the claim's leadership team when a need for group and/or individual training has been identified
Perform focus audits, create ad hoc reports and summarize results for management and/or client
Perform other duties as assigned in support of effective, efficient operations related to provider contracting and reimbursement
Qualification
Required
Working knowledge of medical terminologies and coding, proven experience in a claim's environment, and understanding of HIPAA Confidentiality laws
Excellent written and oral communication, interpersonal, and negotiation skills with a demonstrated ability to prioritize tasks as required. Demonstrated problem-solving/analysis skills
Proven experience building and running SQL queries. Demonstrated experience with Microsoft Office (Word, Excel, Outlook, and PowerPoint)
Strong analytical aptitudes, communication, and comprehension capabilities
Enthusiastic attitude, cooperative team player and demonstrated ability to adapt to new or changing circumstances
Bachelor's degree and a minimum of 5 years of advanced claims adjudication experience including facility, professional and ancillary claims; and a minimum of 3 year's experience auditing of claims adjudication
Company
Yale University
Yale University is a research and education institution that prioritizes its students.
10001+ employees
H1B Sponsorship
Yale University has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (355)
2024 (449)
2023 (214)
2022 (208)
2021 (190)
2020 (155)
Funding
Current Stage
Late StageTotal Funding
$42.86MKey Investors
Bezos Earth FundAlfred P. Sloan FoundationHyundai Hope On Wheels
2025-10-23Grant
2025-05-21Grant· $0.05M
2023-01-01Grant· $1.27M
Leadership Team
Geoffrey Chatas
Senior Vice President for Operations
Jack Callahan
Senior Vice President for Operations
Recent News
2025-12-10
Company data provided by crunchbase